Shalom House, Inc.

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

229743 Issued in ME

Legal business name

SHALOM HOUSE, INC.

Practice address

106 Gilman St
Portland, ME 04102-3034

Phone

(207) 874-1080

Fax

(207) 874-1077

NPI assigned

Jul 6, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Mary Haynes-Rodgers

Title

Executive Director

Phone

(207) 874-1080

Specialties & licenses 2

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1232668800000",
    "number": "1992702955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 GILMAN ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041023034",
            "telephone_number": "207-874-1080",
            "fax_number": "207-874-1077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 GILMAN ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041023034",
            "telephone_number": "207-874-1080",
            "fax_number": "207-874-1077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHALOM HOUSE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-06",
        "last_updated": "2009-01-23",
        "status": "A",
        "authorized_official_last_name": "HAYNES-RODGERS",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "207-874-1080",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "ME",
            "license": "229743",
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "ME",
            "license": "229743",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "16780000",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "167860101",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Prasheen Piyush Shah, MD
• Ravindra Arvindkumar Shah, MD
• Rosellen Provost Shahidi, MD
• Ryan Shahidi, DO
• Amaan Shaikh
• Mukiza Gloire Shamaragwe
• Ashley Shamos, NP
• Tanya Shan, PH.D.
• Alyson Shannon, LMT
• Bryant Christopher Shannon, MD

• Mental Illness Community Based Residential Treatment Facility in Portland, ME
• Providers in Portland, ME by specialty
• Mental Illness Community Based Residential Treatment Facility in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.